This article reviews the efficacy and safety of minimally invasive treatments for lower urinary tract symptoms in patients with BPH. It systematically examines various techniques like prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), high-intensity focused ultrasound (HIFU), laser treatments, and cryoablation. These methods provide alternatives to surgery (TURP) especially for patients unfit for surgery or those who experience medical treatment failure.

The treatments generally result in fewer side effects compared to TURP, such as a reduced risk of bleeding, erectile dysfunction, and retrograde ejaculation. Each method has specific benefits: PAE can reduce prostate volume but is limited because it can be technically challenging due to vascular abnormalities. TUNA and TUMT avoid general anesthesia, while laser treatments are more effective for larger prostates. TUNA is less effective in completely removing prostatic obstruction, and TUMT may be less effective for long-term relief of LUTS. HIFU is non-invasive and can be performed under either ultrasound or MRI guidance, allowing for precise targeting but heat loss and the difficulty in focusing energy on the target tissue limit its efficacy. Therefore, TURP remains the gold standard for long-term efficacy, particularly for severe symptoms, though minimally invasive approaches offer safe alternatives, especially for specific patient groups. The article calls for more long-term studies to assess the durability of these treatments.

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